Peer review system is one of the most important processes to secure objectivity in sciences. Manuscripts submitted by any author, even if he or she is new comer or veteran, must be read critically by other scientists who have enough experience and extensive knowledge on related fields. While any person such as self-proclaimed scientists can publish their “new discoveries” in blogs, general books and/or open access predatory journals without undergoing review and editing process, their findings offer very little scientific information and occasionally cause health problems. Critical reading and reviewing scientific manuscripts takes times and efforts for scientists who would like to spend their own precious time for clinical or research activities. However any member of scientific community has moral obligations to read critically unpublished manuscripts as well as published ones in order to reach better scientific truth. In this sense, it is important to learn authentic manner to review manuscripts. For young scientists, peer-review experiences are also useful for responding to peer-reviewed opinions against their own manuscripts.

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The nutritional status of elderly people tends to be affected by comorbidities and individual differences. Malnutrition increases the risk of progression and development of sarcopenia and frailty in the elderly, less than 75 years of age. Further, malnutrition influences quality of life, such as the instrumental activities of daily living, mental state, and cognitive function, and shortens the healthy life span in elderly people. Hence, eligible comprehensive geriatric assessments, including nutrition assessment, are needed before establishing a management plan for malnutrition in elderly people. Appropriate management to prevent malnutrition must be planned in consideration of the individualized clinical, social, economical and familial features. Nutritional management in elderly people against developing the sarcopenia and frailty contributes to the prevention of impairment of quality of life and shortness throughout the healthy life span.

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Sedentary lifestyles and dietary changes have resulted in an increasing number of obese subjects in Japan, as in Western countries. The number of complications affecting Japanese adults increases in relation to the body mass index (BMI), with a progressive increase in BMI ≥ 25, as well as 100 cm2 or greater visceral fat area. Thus, the Japan Society for the Study of Obesity has defined obesity as a BMI ≥ 25 and coined the term ‘obesity disease’ as a condition characterized by the presence of associated complications or their likely occurrence in an obese person. What is critically important is that a person in this situation needs to lose weight for medical reasons. To achieve clinically meaningful weight loss, lifestyle interventions together with reducing dietary calories, regardless of which macronutrients the patients emphasize, is the optimal approach. Herein, we explain how to treat people with obesity disease using diet therapy in Japan.

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In recent years, the development and approval of direct acting antivirals (DAAs) for the treatment of hepatitis C has resulted in a high rate of sustained viral response (SVR). Furthermore, nucleoside analogues are able to control HBV replication, and it has thus become possible to treat viral liver disease. However, number of patients with alcoholic liver diseases or nonalcoholic fatty liver diseases tends to increase of treatment for them are urgently needed. In addition, in the super-aging society, it is also necessary to emphasize measures against various complications for elderly patients with cirrhosis, and approaches, such as diagnosis, prevention, and therapeutic intervention of sarcopenia, have drawn recent attention. Thus, the disease background and treatment strategies continue to change due to various factors, such as the appearance of new therapeutic agents and the aging of patients. Metabolism in the liver, which is considered to be the largest organ in the human body, is the core of the treatment, and the nutritional source(s) leading to it is also at the foundation of the treatment. In this article, we describe the nutritional therapeutic options according to each condition.

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The estimated energy requirement for the majority of patients with chronic kidney disease (CKD) is 25–35 kcal/kg/day, but it should be set for individual patients in consideration of their gender, age, and physical activity level. Dietary prescription should be assessed and optimized over time by monitoring the changes in the body weight of the patients. The Evidence-based Clinical Practice Guidelines for Chronic Kidney Disease 2018 established by the Japanese Society of Nephrology recommend individualized protein restriction for patients with CKD in accordance with their specific clinical condition, in addition to nutrition guidance consisting of a low protein diet under the management of the medical team with nephrologists and registered dietitians. To prevent hypertension, proteinuria, and cardiovascular disease (CVD), salt intake should be restricted to below 6 g/day. It is recommended to set a lower limit for each patient of 3 g/day as a guide because extreme salt restriction could be harmful. It was also suggested that serum potassium levels should be maintained between 4.0 and 5.4 mEq/L to support the reduction of mortality and CVD in patients with CKD.

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Carbohydrates are among the major nutrients, including dietary fibers which do not contribute to blood glucose rises in humans. The major dietary carbohydrates are classified into three groups, sugars, oligosaccharides, and polysaccharides, based on the degree of polymerization. Among the dietary carbohydrates, glucose (monosaccharides), maltose, sucrose, lactose (oligosaccharides), and starch (polysaccharides) provide food-derived blood glucose and contribute to increases in the postprandial glucose level. Hence, the proportion of carbohydrate in dietary food has an important effect on glucose metabolism in diabetes. Starvation therapy using a low-carbohydrate diet was the main dietary treatment until the discovery of insulin in 1921. Insulin treatment contributed to shift from low-carbohydrate to low-fat dietary treatment that has been established to date. Conversely, the recent role of low-carbohydrate diet therapy is reviewed and debated the therapeutic benefits concerning the diabetes treatment and prevention of diabetes complications. This review presents the summary and clinical considerations of the low-carbohydrate diet treatment.

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Carbohydrate counting is used in dietary therapy for diabetes based on the concept that the postprandial rise in blood glucose levels is primarily affected by ingested carbohydrates. Carbohydrate counting consists of two methods, “basic” and “applied”. Basic carbohydrate counting involves knowledge about the content of carbohydrates in various food and the methods of optimal daily food intake for diabetes patients. Basic carbohydrate counting is mainly used for patients with type 2 diabetes. Applied carbohydrate counting coordinates the appropriate insulin dose to resolve the elevation of postprandial glucose that is influenced by the amount of carbohydrate. Applied carbohydrate counting contributes to improvement of the fluctuation of postprandial glucose levels, thus, providing the freedom of diet for type 1 diabetes patients. This review describes the outline and clinical approach of carbohydrate counting.

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[in Japanese]

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